The primary goal of stroke rehabilitation is to maximize patients’ physical, mental, social, occupational, private, and educational potential according to their wishes and life plans.
Basic Principles of Rehabilitation:
- Ensuring the planning and execution of treatments for comorbid diseases.
- Preventing or minimizing secondary complications.
- Replacing lost motor function.
- Compensating for sensory and perceptual losses.
- Ensuring environmental compliance.
- Encouraging socialization.
- Creating a high level of motivation.
- Ensuring independence in functional and home life.
- Providing vocational rehabilitation.
Rehabilitation Potential and Prognostic Factors:
Factors that positively affect prognosis:
- The young age of the patient.
- No previous stroke history.
- Absence of urinary and fecal incontinence.
- Left hemiplegia
- Absence of sensory defects.
- Early development of motor functions, especially in the upper extremity and hand.
- Little or no mental disorders.
- Absence of progressive systemic disease (heart, kidney).
- Familial support.
- High education and socioeconomic level.
- Early initiation of rehabilitation.
Factors that negatively affect rehabilitation potential and prognosis:
- The old age of the patient.
- Ongoing sensory deficit and thalamic pain syndrome.
- A long period of unconsciousness after stroke.
- Urinary and fecal incontinence.
- Persistent flaccid hemiplegia, extrapyramidal syndrome with severe rigidity.
- Presence of mental and psychological disorders.
- Stubborn coordination and balance disorder.
- Right hemiplegia and aphasia.
- Chronic heart failure, unresponsive to medical treatment, nephrosclerosis, hypertension.
- Absence or development of motor functions.
- Co-development of spasticity and deformities.
- Delayed initiation of rehabilitation.
- Localized pain (such as shoulder, wrist, hip).
- Visual and spatial deficits.
Treatment for hemiplegia patients is initiated after their general condition has improved. Rehabilitation can be divided into three periods: the acute period, the convalescent period, and the late period.
From the time of stroke diagnosis, the focus is on preventing and treating general medical complications, such as neurological deterioration, pneumonia, deep vein thrombosis, pulmonary embolism, urinary infection, cardiac arrhythmias, and ischemic heart diseases. Pharmacological treatment to protect neural tissues should be administered within the first 6 hours. Ventilation support or surgical decompression may be required. Clinical problems in stroke patients are often related to immobility and loss of physiological condition, making early mobilization essential. The primary goal during the acute period is early mobilization. Attention should be paid to bed positioning, and patients should be repositioned every two hours to prevent complications that may develop due to prolonged lying down. To prevent deformities, maintain joint range of motion, increase proprioceptive sensation, stimulate flexion and extension reflexes, and prevent muscle atrophy, passive range of motion exercises should be performed several times a day. A pillow should be placed under the arm to keep the arm in abduction and external rotation, the forearm should be on the pillow in flexion or extension, and the fingers should be in the semi-flexion position when the wrist is extended. The lower extremity should be in a neutral position, and external rotation of the hip should be avoided, with the ankle kept in 90-degree dorsiflexion.
During this period, the active rehabilitation program continues. It takes 1-3 weeks for the patient’s condition to stabilize. Flexibility, strengthening, coordination, endurance, and balance exercises are given, and patients are taught to perform activities of daily living with the intact side, such as dressing, undressing, and eating. Sitting balance in bed is developed, and training is given to perform transfer activities. Ambulation training is started in patients who have the ability to follow verbal or signal commands, gain standing balance, do not have contractures in the hip, knee, and ankle, can make voluntary stabilization, and have position sense on the affected side.
During this period, patients may develop serious complications, and the focus is on treating these complications while continuing the rehabilitation program. Upper extremity functions are much more complex in hemiplegia rehabilitation, making upper extremity rehabilitation less successful when compared to lower extremity rehabilitation.